As the name of this blog makes clear, the authors believe that the public is best served when the institutions of medicine and health care are science-based. The basis of medicine has many levels and institutions in our society. They include not only the practitioners of medicine, but hospitals, medical schools and other academic institutions, government and regulatory agencies, industry, insurance companies, the legal system, media, and (last but not least) the public. Defending science-based medicine requires advocacy at every level.

Arguably, the acceptance of science-based medicine at all levels is influenced greatly by public opinion (too much, in my opinion, as a profession, almost by definition, should rise above the lowest common denominator of public opinion), and public opinion is influenced greatly by the mainstream media. There is one issue, however, for which public opinion has a direct and measurable effect on the efficacy of a medical intervention and that is the vaccination program. Therefore we pay particular interest to how the media deals with the issue of vaccines, especially the recent false controversy over an alleged link between vaccines and autism.

It is my observation (and also supported by a recent study) that the quality of mainstream science reporting has been generally low, attributed to the scaling back of dedicated science journalists. On this issue I have found the reporting to be mixed, with both good and bad examples, but with the highest quality outlets generally getting the story right. This week Time magazine’s cover story is The Truth About Vaccines by Alice Park. The article is excellent – it covers the controversy without pandering and without pretending that there is more of a scientific controversy than there is. She states quite succinctly that the evidence has been evaluated by scientific organizations and there simply is no credible evidence for a link between autism and vaccines.

She hits many of the highlights of the important points against the antivaccinationist claims. For example:

- Proponents of a vaccine-autism link claimed that the mercury-based preservative in some vaccines, thimerosal, was responsible for the link to autism. However, thimerosal was removed from all routine childhood vaccines in the US by 2002 (with only trace amounts in some flu vaccines, which are optional). After the removal of thimerosal autism cases continued to rise unabated, obliterating any claim to a significant link.

- Vaccine critics say the increased vaccine schedule overwhelms the immature immune systems of young children. However, while the number of vaccines has increased, they are more targeted due to improved technology and scientific knowledge. Today’s vaccine schedule contains about 150 antigens (immune stimulating proteins), which is less than the 200 proteins that older vaccines contained.

- Widespread compliance is critical for “herd immunity” to be effective. This is critical because some people cannot get vaccines for medical reasons and they depend on the rest of us to be vaccinated. Voluntary refusal of vaccination has led to outbreaks of diseases like measles that vaccines effectively protect against.

- Vaccines partly suffer from their own success. Parents today never had to live through polio or small pox epidemics.

Overall an excellent article. There are still more points that are critical to the debate that she did not cover, but it is difficult to capture them all in a single article (I assume there were length limitations). For example:

- While parents may first notice the symptoms of autism around the time that vaccines are being given, new studies show that signs are present much earlier, perhaps as early as 4-6 months. If the signs of autism are present before the vaccines are even given, that, of course, falsifies the vaccine-autism hypothesis.

- Evidence is increasingly pointing in the direction that autism is predominantly a genetic disorder or group of disorders. This does not rule out environmental influences entirely, but is argues against autism being primarily due to a toxin.

The scientific debate has largely been fought and resolved – there is no credible and significant link between vaccines and autism. But the public relations battle still rages, and the anti-vaccine side has been doing remarkably well recently. They have a good slogan (green our vaccines) and have been very energetic. In the battle between science and propaganda, propaganda has the short term advantage. While I think science has the long term advantage (because in the end legitimate science is more likely to be correct), a great deal of harm can be done in the meantime.

Park’s article in Time does a good job of pointing that out – irrationally rejecting vaccines causes harm, not only to your own children but to others. It is critical that we continue to point that out to the public. This is not just an abstract battle over how to interpret arcane medical data. Medicine is an applied science and the science behind vaccines has direct public health implications. The subtitle on the cover of Time puts it very succinctly:

Worried about autism, many parents are opting out of immunizations. How they’re putting the rest of us at risk.

18 thoughts on “The Media and Vaccines”

It is refreshing to see a rational discussion of the vaccination isssue covered in a high visibility publication. As useful as the information on this bog is, it just does not have the exposure to counter the mass media stupidity that is out there.

Thanks, Steve, for a refreshingly optimistic article on this blog. The overall tone conveyed on this blog seems to be that rationality is losing the fight over how society should be run. Reading the full 50 pages of Dr. Atwood’s critique of TACT left me a tad despondent.

It’s nice to know that there is some good work being done in mainstream media as well.

jonny_eh, it would be great if this blog is more widely read than I suggested. It is certainly a great information source. I don’t think the readership is up with Time’s just yet. Maybe I’m wrong – I’ll go with the evidence.

I went over to http://www.time.com and found that if you click on Alice Park’s name you can leave feedback for the editors. I would encourage readers of this blog to go over and leave a favorable comment. Mass media should be told when they do something right.

People hate to be wrong and hate to be corrected. Even when they are presented with facts, information, and details of precisely how and why they are wrong, they continue on with their thoughts and ideas and just get offended at you for pointing out their errors.

I’m a self-proclaimed Urban Legend fighter. You know the Urban Legends I’m talking about: Microsoft will donate $0.10 for every forwarded email . . . or please help the missing girl Penny blah blah by sending this email to ten friends . . . or watch out for perfume salesmen in parking lots . . . You get the point. We’ve all seen them and maybe even fell for them by reading them in their entirety and sending them to people we know. I’m sure we all know someone who habitually forwards every email chain, form email, and Urban Legend that has ever existed to every person in their email distribution list.

Whenever I get one of those ridiculous emails, I quickly check http://www.snopes.com (great site, but has annoying pop-ups) and 99% of the time I immediately find the history of the Legend and tons of facts as to why the Legend is total crap, or why it was true years ago but is no longer valid, or on the very rare occasion, why the email Legend is true and why. I then send a polite reply and send a link to the sender stating that they just sent an Urban Legend and that their worries are not valid and that there are many facts to back why no truth exists to support their panicky email storm.

This action is great to get removed from peoples’ email distribution lists, but is also an interesting experiment to gauge peoples’ reactions to being corrected with accurate, documented, and published facts; I have never seen someone gladly accept the information, thank me for correcting them, and politely reverse their position. They always act offended and hostile and go on to 1) insist they are correct and that Snopes is wrong and that their “friend of a friend knows someone that the [insert event] actually happened to”, 2) they go off in a huff that we still need to be cautious and that it can’t hurt to forward emails warning people about the perils of life no matter how stupid they appear, or 3) they don’t reply at all.

My point is that I believe no matter how much information and scientific/medical facts exists to show vaccines are in no way related to ASD, people will continue to blame vaccines and will continue to argue the case. There is no way to win against an emotionally charged topic like this especially when fought by parents of autistic children and Hollywood types. I’m glad Time published this article and that SBM picked up on it and posted this blog, and I hope I’m wrong and this silly argument goes away and people come to their senses, but I suspect this will be around for a very long time regardless of the facts.

Then, neurologists do not recognise such a thing as regressive autism? I think the public needs an explanation for the children who supposedly developed and socialized normally and then lost capacbilities. These are powerful stories and unlikely to be neutralised in the public mind by the kind of studies you describe. They need to be directly addressed/explained somehow.

Personally, I’m waiting for the letters section next week or the week after. TIME is going to catch a lot of flak from antivaccinationists. I predict some serious craziness in the letters section.

As for the issue of regressive autism, it’s almost always the case that these children who regressed were not “normal” from the get-go. Retrospective examination of videotapes of these children (when they exist) almost always demonstrate to the trained eye that differences in socialization or other traits associated with autism were there long before the “regression.” Indeed, this was the case with Michelle Cedillo (the child who was the first test case for the Autism Omnibus), and there is even now research suggesting that autism can be diagnosed as early as four to six months of age. True, these children “seem normal,” particularly to first time parents who have no yardstick against which to measure their behavior before age one, but it is clear that autism is probably there from birth. Now, what triggers regression is a difficult question to which we don’t yet have a good answer. Unfortunately, regression often occurs in the age range when children are getting most of their vaccines, hence the seeming association. Even more unfortunately, this is a concept that is very hard to get across to parents, because human beings seem to be hard-wired to infer causation from correlation.

DBonez: I love your references to debunking urban legends, I’ve been on the same quest for years! I recall a few years ago when I was working at a U.S. Naval Hospital overseas during the days when frequent chain warning e-mails exclaimed “…this virus will erase your hard drive!” A fresh young naval officer forwarded one of these panic e-mails out to a gigantic all-Europe U.S. Navy mailing list which included me and at least one admiral. I was aware that the supposed virus warning was totally bogus. In fact, it had been floating around for a couple of years. I replied to the entire mailing list with significant documentation of the erroneous computer virus warning and I received a number of “thank you” responses. However, the officer who originated the e-mail responded to me with a flaming e-mail, he was absolutely incensed that I had publically corrected his actions with, like you said, “accurate, documented, and published facts.” I suppose it wasn’t very diplomatic to correct him in such a public manner but I sure hope he learned his lesson!

I don’t really have much to say, but I have been reading this blog since day one and I really appreciate the effort, and most of all, the clarity of the information provided. Very rarely are the posts colored with emotional reasoning, and that is a rare quality. I hope that your efforts encourage more articles like the one in Time Magazine.

My idea is that “regression” occurs as a consequence of an immune system activation, where transient high NO due to iNOS reprograms the basal NO level slightly lower by feedback inhibition of nNOS and eNOS expression, which then decreases the range of the NO released during neuronal activation (the cause of the BOLD signal) which lowers the functional connectivity of the brain which then drops below the percolation threshold and the functionality of the neural network drops exponentially especially in regions using NO to mediate social behaviors.

I see this “regression” as similar to the “regression” that occurs during instances characterized by T2 diffusion hyperintensities.

Ever considered the antigen loads that hit a newborn without vaccines? Most of the mnaterial in the birth canal is foreign antigens, – the bacteria, mucus, mom’s blood, fecal matter, etc. Everything in the delivery area’s air – from the midwife’s shed skin cells to the dust mite feces – has one or more antigenic proteins.

How many antigens are in the bacteria, cat dander and whatever a rugrat collects when crawling across the carpet? A cat scratch? A pin prick? Using the dog’s paw for a teething ring? Chewing on the kid next door?

“Ever considered the antigen loads that hit a newborn without vaccines? Most of the mnaterial in the birth canal is foreign antigens, – the bacteria, mucus, mom’s blood, fecal matter, etc. Everything in the delivery area’s air – from the midwife’s shed skin cells to the dust mite feces – has one or more antigenic proteins.

How many antigens are in the bacteria, cat dander and whatever a rugrat collects when crawling across the carpet? A cat scratch? A pin prick? Using the dog’s paw for a teething ring? Chewing on the kid next door?”

I made the same points (as “David”) when trying to counter the antivax nonsense being spouted by posters on Melanie Philips’ opinion piece about Hanah Poling and vaccines in the Spectator.http://www.spectator.co.uk/melaniephillips/569281/another-piece-in-the-jigsaw.thtml
It is also worth pointing out that the old whole cell pertussis vaccine contained over 3000 distinct antigens, as opposed to the handful in the current acellular vaccine. The immune “load” from vaccines has reduced over the last 40 years, not increased.

Thanks for the article, as always. It even provided me with one of the rare tidbits on this issue that I hadn’t known before: the reduced antigen load in the modern schedule. I’ll be sure to stop by the magazine’s website and add a comment, as well.

My youngest has had to delay her latest shots due to two separate infections (nerve-wracking, as I’m paranoid about pertussis, and one involved a rather severe cough), but I can at least say that there’s never been any doubt that my kids will get their shots, and get them as on-time as possible.

I have to commend TIME on their publications for kids, as well. They do some very good basic science and nature stuff. My four-year-old devours them, and they leave me a lot of room to expand and teach. I guess I have two comments to leave, then…

I would like to see more posts like this on health scares. Is there a ‘heath scares’ section on this site?

You could sure use a post on bisphenol A (BPA). I was interviewed by a reporter about this last week and I brought up the autism and vaccine scare as a health scare that can have dire consequences compared to say the BPA scare. The BPA scare is arguably benign (notwithstanding plastic water bottle waste and confused and scared parents).